Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment: A Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: Questions remain about the role and durability of bariatric surgery for type 2 diabetes mellitus (T2DM). OBJECTIVE: To compare the remission of T2DM following surgical and nonsurgical treatments. DESIGN, SETTING, AND PARTICIPANTS: In this 3-arm randomized clinical trial conducted at the University of Pittsburgh Medical Center from October 1, 2009, to June 26, 2014, in Pittsburgh, Pennsylvania, outcomes were assessed 3 years after treating 61 obese participants aged 25 to 55 years with T2DM. Analysis was conducted with an intent-to-treat population. INTERVENTIONS: Participants were randomized to either an intensive lifestyle weight loss intervention for 1 year followed by a low-level lifestyle intervention for 2 years or surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) followed by low-level lifestyle intervention in years 2 and 3. MAIN OUTCOMES AND MEASURES: Primary end points were partial and complete T2DM remission and secondary end points included diabetes medications and weight change. RESULTS: Body mass index (calculated as weight in kilograms divided by height in meters squared) was less than 35 for 26 participants (43%), 50 (82%) were women, and 13 (21%) were African American. Mean (SD) values were 100.5 (13.7) kg for weight, 47.3 (6.6) years for age, 7.8% (1.9%) for hemoglobin A1c level, and 171.3 (72.5) mg/dL for fasting plasma glucose level. Partial or complete T2DM remission was achieved by 40% (n = 8) of RYGB, 29% (n = 6) of LAGB, and no intensive lifestyle weight loss intervention participants (P = .004). The use of diabetes medications was reduced more in the surgical groups than the lifestyle intervention-alone group, with 65% of RYGB, 33% of LAGB, and none of the intensive lifestyle weight loss intervention participants going from using insulin or oral medication at baseline to no medication at year 3 (P < .001). Mean (SE) reductions in percentage of body weight at 3 years were the greatest after RYGB at 25.0% (2.0%), followed by LAGB at 15.0% (2.0%) and lifestyle treatment at 5.7% (2.4%) (P < .01). CONCLUSIONS AND RELEVANCE: Among obese participants with T2DM, bariatric surgery with 2 years of an adjunctive low-level lifestyle intervention resulted in more disease remission than did lifestyle intervention alone. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01047735.
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MBS is superior to lifestyle intervention for remission of type 2 diabetes at 3 years after surgery in a trial with 43% of subjects with class I obesity.
“A 3-arm randomized controlled trial that had 43% of its subjects with class I obesity, demonstrated that MBS is superior to lifestyle intervention for remission of T2D, 3 years after surgery [33].”
Clinical trials of bariatric surgery in patients with type 2 diabetes have consistently shown improvement in cardiovascular risk factors, including better glycemic control, lower blood pressure, higher high-density lipoprotein cholesterol, and lower triglyceride levels.
“clinical trials of bariatric surgery in patients with T2DM have consistently shown improvement in cardiovascular risk factors, including better glycemic control, lower blood pressure, higher high-density lipoprotein cholesterol, and lower triglyceride levels”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [177]
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- Authors
- Courcoulas, A. P., Belle, S. H., Neiberg, R. H., Pierson, S. K., Eagleton, J. K., Kalarchian, M. A., DeLany, J. P., Lang, W., & Jakicic, J. M.
- Affiliations
- University of Pittsburgh Medical Center (US)
- University of Pittsburgh (US)
- Wake Forest University Health Sciences (US)
- Duquesne University (US)
- ORCID
- Venue
- JAMA Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2015-10-01
- Volume
- 150
- Issue
- 10
- Pages
- 931
- ISSN
- 2168-6254 (ISSN-L)
- PMC
- PMC4905566
- OpenAlex
- W2157418166
- Cited by
- 376
- References
- 44
- Citations by year
- 2026: 16 · 2025: 24 · 2024: 26 · 2023: 28 · 2022: 29 · 2021: 28 · 2020: 41 · 2019: 36 · 2018: 45 · 2017: 38 · 2016: 52 · 2015: 13
- FWCI
- 49.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (P30AG024827)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK095128)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- type 2 diabetes, bariatric surgery, Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, diabetes remission, obesity, weight loss, diabetes medication reduction, long-term outcomes, HbA1c, fasting blood glucose, body mass index, young adults, women, African Americans
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Female, Humans, Life Style, Male, Middle Aged, Obesity, Time Factors, Gastric Bypass, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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